# An Uncertainty Estimation Framework for Dose Accumulation in Adaptive Radiotherapy: Application to CBCT-Guided Radiotherapy for Cervical Cancer

arXiv: https://arxiv.org/abs/2606.11012 · HTML: https://mlsanity.com/paper/2606.11012/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 56 references that are in the map.
- First posted on arXiv 9 Jun 2026.

## Builds on (most cited first, 9 of 9)

- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [nnU-Net for Brain Tumor Segmentation](https://mlsanity.com/paper/2011.00848/) (2020)
- [Trustworthy clinical AI solutions: a unified review of uncertainty quantification in deep learning models for medical image analysis](https://mlsanity.com/paper/2210.03736/) (2022)
- [Make Me a BNN: A Simple Strategy for Estimating Bayesian Uncertainty from Pre-trained Models](https://mlsanity.com/paper/2312.15297/) (2023)
- [Calibration and Uncertainty for multiRater Volume Assessment in multiorgan Segmentation (CURVAS) challenge results](https://mlsanity.com/paper/2505.08685/) (2025)
- [Propagation and Attribution of Uncertainty in Medical Imaging Pipelines](https://mlsanity.com/paper/2309.16831/) (2023)
- [NPBDREG: Uncertainty Assessment in Diffeomorphic Brain MRI Registration using a Non-parametric Bayesian Deep-Learning Based Approach](https://mlsanity.com/paper/2108.06771/) (2021)
- [From Registration Uncertainty to Segmentation Uncertainty](https://mlsanity.com/paper/2403.05111/) (2024)

## Abstract (arXiv)

Background and purpose: oART enables daily plan adaptation to interfraction anatomical variations, but cumulative dose estimation remains limited by DIR, segmentation, and anatomical uncertainties. We introduce IMPACT-DoseAcc, an uncertainty-aware dose accumulation framework, within IMPACT for semantic feature-driven image analysis. The framework is modality- and disease-agnostic and is applied to CBCT-guided oART for cervical cancer (LACC). Material and Methods: Nine LACC patients were retrospectively analyzed using daily CBCT-derived virtual CTs for dose recalculation. IMPACT-DoseAcc focuses on uncertainty from DIR, without modeling vCT-generation uncertainty. Two DIR uncertainty strategies were tested within IMPACT-Reg: a Bayesian segmentation-guided approach using one probabilistic model to quantify anatomical uncertainty, and an ensemble of segmentation models targeting structures to capture epistemic variability. Voxel-wise uncertainty maps were propagated through dose warping and accumulation to generate probabilistic dose-volume histograms. Ensemble uncertainty was quantified from voxel-wise standard deviation across deformation fields, and geometric error was assessed using surface distance between warped and validated contours. Anatomical-variability weighting refined aggregation. Results: Ensemble DIR uncertainty correlated with geometric error, with Pearson coefficients of 0.63 for CTVt and 0.66 for bladder. For CTVt, pDVHs achieved 96.3 +/- 3.9% coverage, showing calibration of propagated uncertainty. Weighting stabilized estimates across fractions and organs. Conclusions: IMPACT-DoseAcc propagates registration-driven uncertainty to cumulative dose metrics, improving interpretation of accumulated dose under anatomical variations. Its 3DSlicer integration supports reproducible, uncertainty-informed ART workflows.